Basic Information
| Provider Information | |||||||||
| NPI: | 1598494734 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDANIEL | ||||||||
| FirstName: | TEANDREA | ||||||||
| MiddleName: | LYNETTE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1243 CRANDALL AVE | ||||||||
| Address2: | |||||||||
| City: | NORTON SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494414306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2313435576 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2201 S GETTY ST | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494441207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317399315 | ||||||||
| FaxNumber: | 2317339711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2022 | ||||||||
| LastUpdateDate: | 06/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 4704278246 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.